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Quarantine: U.S. isolates traveler with super TB

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    Posted: May 29 2007 at 2:56pm

U.S. isolates traveler infected with super-TB

Tue May 29, 2007 4:34PM EDT

By Will Dunham

WASHINGTON (Reuters) - The United States has isolated a man who may have exposed fellow passengers on two transatlantic flights to a strain of tuberculosis that is extremely hard to treat, officials said on Tuesday.

It was the first time the federal government has issued such an isolation order since 1963, according to the U.S. Centers for Disease Control and Prevention.

CDC Director Dr. Julie Gerberding said authorities were trying to notify passengers who traveled aboard Air France flight 385 from Atlanta which arrived in Paris on May 13 and on Czech Air flight 0104 from Prague to Montreal on May 24.

The man, from the U.S. state of Georgia, returned to the United States by car and has been in the hospital "in respiratory isolation" since then, the CDC said. He is suffering from extensive drug-resistant TB, known as XDR TB, that resists virtually all antibiotics.

"This is an unusual TB organism, one that's very, very difficult to treat. And we want to make sure that we have done everything we possibly can to identify people who could be at risk," Gerberding said at a news conference.

Authorities did not identify the man, but said he had voluntarily entered a medical isolation facility in New York City.

Tuberculosis is a bacterial infection that usually attacks the lungs. It kills about 1.6 million people annually, with the highest number in Africa. It is spread through the air when infectious people cough, sneeze, talk or spit.

PASSENGERS AT RISK

Gerberding said the plane passengers most likely to be at risk were those seated close to the patient.

"Consistent with the World Health Organization guidelines, CDC is recommending that those passengers be notified by their health officials in their responsible country or state, and that such persons then have a test for tuberculosis to determine whether or not they were in fact exposed," she said.

Others aboard the planes also should be notified so they can be tested for TB, although their risk was not thought to be high, she said.

Gerberding said the patient had "compelling personal reasons" to travel and did so despite the illness. She stressed that he had not broken any laws.

"In this case, the infected patient traveled on two trans-Atlantic air flights and in doing so, may have exposed passengers and crew to XDR TB," the CDC said in a statement.

It was working with U.S. state and local health departments, ministries of health in other countries, the airline industry, and the World Health Organization.

Dr. Kenneth Castro of the CDC's Division of Tuberculosis Elimination said that from 1993 to 2006 CDC knew of just 49 people in the United States with XDR tuberculosis.

XDR TB requires 18 months to two years of treatment with a mixture of four to six drugs. The treatment can often require surgery as well as the newest drugs and can cost $500,000 per patient.

Multidrug-resistant TB is resistant to at least two first-line antibiotics. XDR TB is resistant to first-line antibiotics, and to an entire class of antibiotics called fluoroquinolones, as well as to at least one of three injectable drugs.

Isolation refers to the separation of persons who have a specific infectious illness from those who are healthy. Quarantine refers to the separation and restriction of movement of persons who, while not yet ill, have been exposed to an infectious agent and therefore may become infectious.

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Media Advisory

FOR IMMEDIATE RELEASE
Thursday, May 29, 2007

Contact: CDC Media Relations
(404) 639-3286

Public Health investigation seeks people who may have been exposed to extensively drug resistant tuberculosis (XDR TB) infected person.

WHO:

Dr. Julie Gerberding, Director, CDC
Dr. Martin Cetron, Director, CDC Division of Global Migration and Quarantine
Dr. Kenneth Castro, Director, CDC Division of Tuberculosis Elimination

WHAT:

Release of information about the action and steps that CDC is taking in response to a case of extensively drug-resistant tuberculosis (XDR TB) in a U.S. citizen who undertook international travel.  XDR TB is a recently defined subtype of multi-drug resistant TB and can cause severe illness and death. 

WHY:

Like all forms of TB, XDR TB is a disease caused by germs that are spread person-to-person through the air. In this case, the infected patient traveled on two trans-Atlantic air flights and in doing so, may have exposed passengers and crew to XDR TB.  A federal quarantine order has been issued and CDC is currently collaborating with U.S. state and local health departments, international Ministries of Health, the airline industry, and WHO.

WHEN:

Tuesday, May 29, 2007, 2 p.m. ET
Brief remarks followed by Q&A
Dial-in:

  • US Media: 1-888-795-0855
  • International:   210-234-0025
  • Passcode:     CDC Media

Listen to the Briefing by visiting the webcast link at: www.videonewswire.com/event.asp?id=40136

Transcript

A full transcript of this teleconference will be available following the briefing on the CDC web site at www.cdc.*******od/oc/media/transcripts/t070529.htm .

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Post Options Post Options   Thanks (0) Thanks(0)   Quote 4=laro Quote  Post ReplyReply Direct Link To This Post Posted: May 29 2007 at 8:52pm
I really find it hard to believe that he had to travel (what could be so compelling that he would feel it necessary to risk infecting hundreds of people to an uncurable disease.)  If he is cured, he should be tried and locked up forever.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: May 29 2007 at 9:05pm

He originally flew on May 12th so it's already been a couple of weeks.  Plus the CDC probably had to wait another few days to announce it because of the holiday, so it would have a fairly good head start on everybody.   Incubation is 2 - 10 wks.

 

 

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2 Flights Carried Man With Deadly TB

WASHINGTON, May 29 — Public health officials today urged the passengers and crew of two recent trans-Atlantic flights to get checked for tuberculosis, after learning that a man with an exceptionally deadly and drug-resistant form of the disease had flown on the planes.

The man, an American who was not identified, flew on May 12 from Atlanta to Paris aboard Air France Flight 385, then traveled on May 24 from Prague to Montreal aboard Czech Air Flight 410 before driving back to the United States, the Centers for Disease Control announced. He is currently hospitalized in an isolation ward.

Dr. Julie Gerberding, director of the Centers for Disease Control, announced the matter personally.

While tuberculosis is not highly transmissible, the deadliness of this strain — and the ease of modern transportation — underscored the need for rapid response, as with the SARS virus epidemic of a few years ago.

A federal quarantine order has been issued — the first in decades — and the C.D.C. is working with state and local health departments, airline officials, international health ministries and the World Health Organization, Mr. Gerberding said, according to Bloomberg News. “We felt it was our responsibility to err on the side of abundant caution and issue the isolation order,” she said.

Tuberculosis had been a leading cause of death even in the developed world until the development of streptomycin in the 1940s. Today, treatment by anti-tuberculosis drugs like isoniazid and rifampicin can cure up to 95 percent of patients.

But those and other so-called first-line drugs do little against a type of tuberculosis known as multidrug-resistant TB, or MDR TB. More worryingly, the type of tuberculosis found in the infected American — known as extensively drug-resistant tuberculosis, or XDR TB — resists treatment even by three of the six second-line drugs used when first-line drugs fail. Only two cases of the strain were found last year in the United States.

Tuberculosis is typically spread by sneezing or coughing, and the C.D.C. said the man potentially was infectious during the two flights.

Health officials recommended medical exams for cabin crew members on the flights, as well as passengers sitting within a few rows of the man. Dr. Gerberding would not say the row in which he sat, but the doctor said the nearby passengers would be contacted. More information can be obtained at the Web site of the Centers for Disease Control, www.cdc.gov.

Antibiotics have helped lower tuberculosis rates for years, also though the CDC found some resurgence starting in 1985, particularly among recent immigrants and people infected with HIV, the virus that causes AIDS. Still, TB cases hit an all-time low last year in the United States of 13,767, according to The Associated Press.

But tuberculosis is still deadly, particularly in countries where medical care is lacking, killing about 1.6 million people each year worldwide. It is particularly deadly among those infected with HIV.

At any given time, one person in three worldwide is infected with dormant tuberculosis germs, according to the World Health Organization. People become ill when the bacteria become active, usually when a person’s immunity declines, whether because of advancing age, HIV infection or some other medical problem.

While first-line drugs usually are effective, multidrug-resistant tuberculosis can develop if those medications are misused or improperly administered. That requires treatment with more expensive — and less well-tolerated — second-line drugs, which require treatment courses of 18 to 24 months, compared with six to nine months for first-line drugs.

Misuse or mismanagement of those drugs, in turn, can render them ineffective, leading to the extensively drug resistant TB, or XDR TB. Options for treating it are extremely limited, according to the W.H.O. Only about 30 percent of patients can be cured.

A 2005 survey by the C.D.C. and the W.H.O. found that 10 percent of multidrug-resistant tuberculosis strains met the definition for XDR TB, Dr. Gerberding testified before Congress in March. Cases of the latter were found in 17 countries, most often in the former Soviet Union and Asia. While in the United States just 2 percent of multidrug-resistant TB cases were XDR TB, the figure was 15 percent in South Korea and 19 percent in Latvia.

In one outbreak in South Africa, Dr. Gerberding testified, 41 percent of the 544 patients infected with tuberculosis were found to have multidrug-resistant strains; of those, 53 met the definition of XDR TB.

Of the latter group, all but one person died, on average just 16 days after health workers had tested them

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Post Options Post Options   Thanks (0) Thanks(0)   Quote coyote Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 3:26am
This is exactly how a pand.flu will happen! By ignorant and naive people. He should be tried and locked up. I find it hard to believe that someone could not have stopped him from boarding those planes!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 3:54am
And some are telling me,Dont worry AI well be stoped before it gets here!!!lol
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Post Options Post Options   Thanks (0) Thanks(0)   Quote coyote Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 4:00am
Ya right. OH IT CANT HAPPEN HERE.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 5:57am
I think this is exactly how it will spread...air travel.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 6:00am
This was a link from Matt Drudges site.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 6:27am
WASHINGTON, May 29 Public health officials today urged the passengers and crew of two recent trans-Atlantic flights to get checked for tuberculosis, after learning that a man with an exceptionally deadly and drug-resistant form of the disease had flown on the planes.

I've had the news on last night and this morning, have NOT seen any warnings. Therese said on another AFT post how this is really being played down, I fully agree. I believe this is how the pandemic will start and those who have NOT prepared won't have a chance to prepare. By the time the public is notified we are entering a pandemic situation, everyone will already know someone who has the flu. It will be too late to prep without the dangers of exposure. JMHO
    
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Post Options Post Options   Thanks (0) Thanks(0)   Quote roni3470 Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 6:49am
One question on this specific issue...if you have been vaccinated for TB, can you still catch this strain?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 7:13am
 Apparently the guy is a lawyer who flew to Paris on his honeymoon.   He had no symptoms and was feeling fine, although he knew he was a carrier.  The last time somebody in a similar situation traveled by plane with regular TB, out of a total 925 passengers who came in contact, 15 became infected.  The numbers could be similar.  
 
 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 7:24am
Originally posted by Albert Albert wrote:

Apparently the guy is a lawyer who flew to Paris on his honeymoon.   He had no symptoms and was feeling fine, although he knew he was a carrier.  The last time somebody in a similar situation traveled by plane with regular TB, out of a total 925 passengers who came in contact, 15 became infected.  The numbers could be similar.     
I wonder where the 15 newly possibly infected victims were seated on the plane in relation to the TB infected individual. Earlier we read they were only testing the rows around the TB infected man. I wonder if others in the plane have become symptomatic? This self-centered TB infected man should be held liable for all the expense resulting from his self-centered blatant act.      
    
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 8:34am
The last time somebody with regular TB got on a plane, out of 925 passengers, 15 became infected.  The numbers could be similar.  
 
 
Wow...more information coming out. Geez I think he needed to postpone his honeymoon. His new wife is probably not too happy either ~~
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 8:47am

13 people may have contracted whooping cough from Seton employee

Another 159 people flock to ER for examination, worried they may have been exposed

By Mary Ann Roser
AMERICAN-STATESMAN STAFF
Wednesday, May 30, 2007

Thirteen people, including three infants, might have contracted whooping cough from a Seton Medical Center employee working in the maternity area, and another 159 people showed up in the emergency room fearing that they had been exposed, a Seton official said Tuesday.

The 13 who appeared to have been infected were given antibiotics as a preventive measure, as were all 159 people who came to the ER, said Greg Hartman, a senior vice president for the Seton Family of Hospitals. Two of the 159 had symptoms that might have been whooping cough, he said.

Seton announced Saturday that a worker in the labor and delivery area might have infected some patients and family members with whooping cough, also known as pertussis. Seton said it would offer free examinations and antibiotics for anyone who might have been exposed.

Pertussis, which can appear to be the flu, pneumonia or allergies, can be difficult to diagnose and is highly contagious. Pertussis bacteria are spread by droplets during sneezing or coughing.

Symptoms include a runny nose, a slight fever, watery eyes and severe coughing, which can produce produce a "whooping" sound when a person takes a breath.

Babies younger than a year are at the greatest risk of severe illness, even death, especially those younger than 2 months: too young to be vaccinated against the disease.

No one has died or required hospitalization in the Seton outbreak, Hartman said.

ER visits by those responding to Seton's announcement were steady over the Memorial Day weekend but "trailed off significantly" Tuesday, Hartman said. He didn't know how many people might have been seen by their own doctors instead of coming to the Seton ER.

Seton learned Friday that an employee whom it declined to identify by name, gender or job title probably was infected with pertussis and could have exposed patients and visitors in the labor and delivery areas.

The employee was diagnosed by a doctor with whooping cough, but a definitive diagnosis probably won't be possible because antibiotics had been started, Hartman said.

Seton made private calls Friday to patients who might have been exposed since May 5 because of the potential incubation period, Hartman said.

It consulted with the Austin/Travis County Health and Human Services Department and made a public announcement Saturday in an effort to be as open as possible, Hartman said.

Whooping cough was uncommon for years in Texas and nationally, but the illness has made a comeback in recent years, especially in 2005. That year, Travis County had 525 reports of whooping cough, a fourth of the state's 2,224 cases — more than any other county, according to data provided by the Department of State Health Services. Williamson County was second highest.

Last year, Travis County reported 139 cases, or 15 percent of the state's 954 cases, again the highest of any county, and Williamson County again was second with 109 cases, according to Doug McBride, a spokesman with the state health department.

So far this year, Travis County has had 20 of the state's 227 cases, not counting the recent Seton cases, McBride said. Williamson County has the most cases so far this year with 35, based on preliminary numbers, McBride said.

Health experts don't know why whooping cough cases are more prevalent in the two counties.

Seton Medical Center will continue to examine and offer prescriptions to people who fear that they were exposed between May 5 and Friday, Hartman said.

maroser@statesman.com; 445-3619

 
 
 
Find this article at:
http://www.statesman.com/news/content/news/stories/local/05/30/30whooping.html
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 9:20am
XDR TB is quite deadly.   
 
 

There is currently an epidemic of XDR-TB South Africa. The outbreak was first reported as a cluster of 53 patients in a rural hospital in KwaZulu-Natal of whom 52 died.[3] What was particularly worrying was that the mean survival from sputum specimen collection to death was only 16 days and that the majority of patients had never previously received treatment for tuberculosis. This is the epidemic for which the acronym XDR-TB was first used, and although TB strains that fulfill the current definition have been identified retrospectively,[6][7] this was the largest group of linked cases ever found. Since the initial report in September 2006,[8] cases have now been reported in most provinces in South Africa. As of 16 March 2007, there were 314 cases reported, with 215 deaths.[9] It is clear that the spread of this strain of TB is closely associated with a high prevalence of HIV and poor infection control; in other countries where XDR-TB strains have arisen, drug-resistance has arisen from mismanagement of cases or poor patient compliance with drug treatment instead of being transmitted from person to person.[10] This strain of TB does not respond to any of the drugs currently available in South Africa for first- or second-line treatment. It is now clear that the problem has been around for much longer than health department officials have suggested, and is far more extensive.[11] By 23 Nov 2006, 303 cases of XDR-TB had been reported, of which 263 were in KwaZulu-Natal.[12] Serious thought has been put to isolation procedures that may deny some patients their human rights, but which may be necessary to prevent further spread of this strain of TB.[13]

http://en.wikipedia.org/wiki/XDR_TB

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 12:27pm
This is very serious. There are 3 Pandemics currently - Malaria, TB, and Dengue Fever. TB is likely to be the dark horse. In one cluster 98% CFR in 16 or so days. This makes Avian look like the common cold in terms of contagion, fact it is in the U.S., and also we have nothing to treat it with.
This may well beat AF to the punch, and ironically it is a far tougher foe than Avian in many ways. Those stating the man in travel was not contagious do have have sufficient experience in terms of this particular strain to determine the risk factor.
 
16 days is a fairly quick time to become fatal. Most masks are much more effective against TB than a virus sized particle. Prep up and give coughing people a wide berth.
 
IMHO of course - Medclinician
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Post Options Post Options   Thanks (0) Thanks(0)   Quote roni3470 Quote  Post ReplyReply Direct Link To This Post Posted: May 30 2007 at 12:36pm
I was in the gym at lunch adn this was all over CNN..including the CDC press conference on it.
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Groom With TB Under Federal Quarantine
 Email this Story

May 30, 1:15 PM (ET)

By MIKE STOBBE

(AP) Grady Memorial Hospital in Atlanta, Ga., is shown Wednesday May 30, 2007. An unidentified man with...
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ATLANTA (AP) - A man with a form of tuberculosis so dangerous he is under the first U.S. government-ordered quarantine since 1963 had health officials around the world scrambling Wednesday to find passengers who sat near him on two trans-Atlantic flights.

The man told a newspaper he took the first flight from Atlanta to Europe for his wedding, then the second flight home because he feared he might die without treatment in the U.S.

Centers for Disease Control and Prevention Director Julie Gerberding said Wednesday that the CDC is working closely with airlines to find passengers who may have been exposed to the rare, dangerous strain. Health officials in France said they have asked Air France-KLM (AKH) for passenger lists, and the Italian Health Ministry said it is tracing the man's movements.

"Is the patient himself highly infectious? Fortunately, in this case, he's probably not," Gerberding said. "But the other piece is this bacteria is a very deadly bacteria. We just have to err on the side of caution."

Health officials said the man had been advised not to fly and knew he could expose others when he boarded the jets from Atlanta to Paris, and later from Prague to Montreal.

The man, however, told the Atlanta Journal-Constitution that doctors didn't order him not to fly and only suggested he put off his long-planned wedding in Greece. He knew he had a form of tuberculosis and that it was resistant to first-line drugs, but he didn't realize it could be so dangerous, he said.

"We headed off to Greece thinking everything's fine," said the man, who declined to be identified because of the stigma attached to his diagnosis.

He flew to Paris on May 12 aboard Air France Flight 385. While in Europe, health authorities reached him with the news that further tests had revealed his TB was a rare, "extensively drug-resistant" form, far more dangerous than he knew. They ordered him into isolation, saying he should turn himself over to Italian officials.

Instead, the man flew from Prague to Montreal on May 24 aboard Czech Air Flight 0104, then drove into the United States at Champlain, N.Y. He told the newspaper he was afraid that if he didn't get back to the U.S., he wouldn't get the treatment he needed to survive.

He is now at Atlanta's Grady Memorial Hospital in respiratory isolation.

A spokesman for Denver's National Jewish Hospital, which specializes in respiratory disorders, said Wednesday that the man would be treated there. It was not clear when he would arrive, spokesman William Allstetter said.

CDC officials have recommended immediate medical exams for cabin crew members and passengers who sat within two rows of the man on the flights.

The other passengers are not considered at high risk of infection because tests indicated the amount of TB bacteria in the man was low, said Dr. Martin Cetron, director of the CDC's division of global migration and quarantine.

But Gerberding noted that U.S. health officials have had little experience with this type of TB. It's possible it may have different transmission patterns, she said.

"We're thankful the patient was not in a highly infectious state, but we know the risk of transmission isn't zero, even with the fact that he didn't have symptoms and didn't appear to be coughing," Gerberding said on ABC's "Good Morning America."

"We've got to really look at the people closest to him, get them skin tested."

Dr. Howard Njoo of the Public Health Agency of Canada said it appeared unlikely that the man spread the disease on the flight into Canada. Still the agency was working with U.S. officials to contact passengers who sat near him.

Daniela Hupakova, a spokeswoman for the Czech airline CSA, said the flight crew underwent medical checks and are fine. The airline was contacting passengers and cooperating with Czech and foreign authorities, she said. Health officials in France have asked Air France-KLM to provide lists of passengers seated within two rows of the man, an airline spokeswoman said on condition of anonymity according to company policy.

The man told the Journal-Constitution he was in Rome during his honeymoon when the CDC notified him of the new tests and told him to turn himself in to Italian authorities to be isolated and be treated. The CDC told him he couldn't fly aboard commercial airliners.

"I thought to myself: You're nuts. I wasn't going to do that. They told me I had been put on the no-fly list and my passport was flagged," the man said.

He told the newspaper he and his wife decided to sneak back into the U.S. through Canada. He said he voluntarily went to a New York hospital, then was flown by the CDC to Atlanta.

He is not facing prosecution, health officials said.

"I'm a very well-educated, successful, intelligent person," he told the paper. "This is insane to me that I have an armed guard outside my door when I've cooperated with everything other than the whole solitary-confinement-in-Italy thing."

CDC officials told The Associated Press they could not immediately comment on the interview.

Health officials said the man's wife tested negative for TB before the trip and is not considered a public health risk. They said they don't know how the Georgia man was infected.

The quarantine order was the first since the government quarantined a patient with smallpox in 1963, according to the CDC.

Tuberculosis is caused by germs that are spread from person to person through the air. It usually affects the lungs and can lead to symptoms such as chest pain and coughing up blood. It kills nearly 2 million people each year worldwide.

Because of antibiotics and other measures, the TB rate in the United States has been falling for years. Last year, it hit an all-time low of 13,767 cases, or about 4.6 cases per 100,000 Americans.

Health officials worry about "multidrug-resistant" TB, which can withstand the mainline antibiotics isoniazid and rifampin. The man was infected with something even worse - "extensively drug-resistant" TB, also called XDR-TB, which resists many drugs used to treat the infection.

There have been 17 U.S. XDR-TB cases since 2000, according to CDC statistics.

---

Associated Press writers Malcolm Ritter in New York and Rob Gillies in Toronto contributed to this report.

---

On the Net:

Centers for Disease Control and Prevention: http://www.cdc.*******

Public Health Agency of Canada: http://www.phac-aspc.gc.ca/

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